Funding outcome

Fluid therapy is an essential in the care of critically ill children. During critical illness, children often receive large amount of fluids in the form of resuscitation fluid, hydration fluid, medications, and nutrition. This cumulative fluid given to the patients often exceeds excreted fluid, leading to fluid accumulation. There is growing recognition of the high occurrence of fluid accumulation in critically ill patients and its association with worse outcomes. Recent studies suggest that approximately one-third of the children admitted to the pediatric intensive care developed fluid accumulation. Fluid accumulation is associated with 4 times higher risk of death, in addition to other negative outcomes such as prolonged assisted mechanical breathing and kidney injury. This raises the question whether minimizing fluid accumulation during critical illness could result in improved outcomes. However, the evidence for changing fluid management in critically ill children is lacking. There is currently no clinical data or consensus to help answer this question. We propose to perform an initial study (i.e. pilot trial) to evaluate the safety, feasibility and efficacy of an approach that aims to minimize fluid accumulation compared to standard care in children admitted to pediatric intensive care with serious critical illness. The results of this pilot trial will inform the design of a larger study aimed to answer the question whether this suggested fluid approach can improve the outcomes of these children. Considering the high occurrence of fluid accumulation in this population, superiority of a conservative fluid approach is likely to have high clinical and economic impact.